Help Wanted: Schools Struggle Placing Students in PPEs

By Chris Dimick

Well-trained students make well-trained new hires, which is why professional practice experiences are an important part of HIM education. However, PPE coordinators say it is getting harder to place students in today’s hectic workplace. Yet the benefits, they say, are there for everyone.

Clarice Jefferson shouldered a large stack of patient charts and eyed the rows of racks.

The 27-year-old college junior had practiced pulling patient charts back in the classrooms of the University of Illinois at Chicago (UIC). But this was not practice. Real patient data moved between her fingers as she cranked open one retractable medical record storage rack, then another.

A lesson on terminal digit filing fresh in her mind, Jefferson dashed into the racks, disappearing into a thick forest of medical records. She emerged with a proud smile, her stack a little bigger.

“It was very intimidating when I first saw it [the record storage racks],” Jefferson says. “But once you get used to the environment it is not hard at all.”

Every Friday for 14 weeks, Jefferson put her HIM education to the test at Rush-Copley Medical Center, based in Aurora, IL, during her junior professional practice experience (PPE). The PPE is a vital part of CAHIIM-accredited HIM programs, program directors say, giving students first-hand education that cannot be replicated in the classroom.

But over the last several years, PPE coordinators say they have found it increasingly harder to place PPE students into acute care facilities. There are not enough HIM professionals willing to take on students.

The shortage affects both students and organizations, because a poorly trained student equals a poorly trained new hire.

“This is becoming a very serious issue for all schools,” says Karen Patena, RHIA, the HIM undergraduate program director at UIC. “And the profession is going to die if we don’t get these kids out there and getting some experience.”

Vital Experience

The PPE is an integral experience for HIM students, Patena says. Reading about HIM is one thing. Doing it makes it real. “No matter how much theory you get, it really becomes more concrete and real when you can actually see it,” Patena says.

PPE gives students a chance to experience their future profession, and provides on-the-job training they will use their entire career. The PPE can be a student’s first step into a hospital. The experience allows students to not only learn HIM skills, but learn if the profession is right for them, Patena says. It takes HIM theory and puts it into practice.

PPE programs operate in various ways in college HIM programs across the country. Typically, students seeking their bachelor’s degree in HIM conduct at least two PPEs. The first “technical” program begins in the second semester of the junior year.

This 14-week on-site internship occurs once a week in an acute care hospital. Students shadow different HIM staffers each week to learn the various areas of the department and facility, from record assembly to coding. Usually the HIM director serves as the student’s mentor and helps guide them through the experience. Though students at UIC do one-day tours of healthcare facilities at the start of their program, the junior PPE is their first chance to do actual HIM work.

A preset schedule developed by the student’s school guides the HIM director and students on what HIM areas to focus on each week. A student’s curriculum in the classroom can be linked to their PPE visits. This ensures, for example, students have some background with coding before coding live charts at their PPE facility, Patena says.

The goal of the junior-year PPE is to expose students to the basic inner workings of the HIM department and a healthcare facility. Jefferson is thankful she has a chance to work hands-on with HIM. “Everything I do is like, ‘Oh, I’ve learned this already, and here it is hands-on,’” she says. “Which is great.”

The second PPE takes place in the final semester of a student’s senior year. This month-long internship, which occurs every weekday, is the “managerial” program and places students in one of a variety of healthcare settings such as EHR vendors, insurance companies, and healthcare associations. In the senior internship, students work on more advanced projects, and they work closely with a mentor in a leadership position.

Harder to Place Students

PPE coordinators in schools around the country are finding it more difficult to place HIM students into PPE facilities, educators say.

The number of regrets and unreturned phone calls PPE coordinator Barb Glondys, RHIA, receives from HIM directors has steadily increased each school year, she says. A coordinator at UIC for 13 years, Glondys and her fellow PPE site coordinators hear many reasons why facilities cannot host students: the Joint Commission is coming, the facility is implementing an EHR system, they have too much work and too few resources. Most commonly, Glondys says, they lack the time.

Sites that once took students now decline. Making matters worse, every new HIM program that is launched puts further strain on the number of PPE sites available for students. More programs may open, but the number of acute care facilities in the area remain the same, Glondys says.

Usually the HIM director wants to take on a student, Patena says. “They just are feeling so overwhelmed, like all businesses are right now,” she says. “There is just a lack of staff and resources, and we are asking them to do more with what little they have.”

Typically, coordinators have a harder time placing junior students than seniors in PPEs. Since the junior student shadows every section of the HIM department over a 14-week period, the commitment can seem like a burden to facilities.

In addition, juniors do not have a high enough level of HIM experience that allows them to help out with extensive work. Senior PPE students are at a facility every day for a month and can dig into specific projects. Seniors also can be placed in a variety of settings that employ HIM professionals, while juniors generally do their PPEs in acute care facilities.

Difficulties Lead to Shortcuts

To date, Glondys has never failed to place a student in a PPE site. But placing students is always a lengthy process and usually takes months before all PPE students find a home.

Because of the unwillingness of healthcare facilities to allow students access, some PPE coordinators and HIM program directors have had to modify their programs.

“Instructors are really scrambling to provide the students a professional component,” Glondys says. “And they are stretching the bounds of what is professional practice experience.”

Some schools are increasingly using the AHIMA Virtual Lab and other on-campus tutorials to supplement or replace experiences students would get during visits to actual healthcare facilities, Glondys says, who is also the manager of e-learning curriculum and training at AHIMA and a Virtual Lab staff member. The Virtual Lab offers academic HIM programs online access to HIM software and systems that can be used to train students.

While the Virtual Lab is an invaluable tool for HIM education, it cannot replace the live HIM environment experienced during a PPE, says Kathy Cliggett, MA, RHIA, an HIM assistant professor at Gwynedd-Mercy College. Cliggett, who is on the AHIMA Virtual Lab Strategic Advisory Committee, says students come back from their PPE with unique perspectives that cannot be learned online.

“It is always interesting to hear their perspective on the dynamics of the HIM department, which they would not get with the Virtual Lab,” Cliggett says.

Schools have been forced to ask facilities to take two students at once. This is not ideal, Patena says, because students have a more educational experience when they interact with HIM professionals on their own. Paired students could lean on each other, and not learn for themselves, Glondys says. UIC has even limited its class size to 25 juniors and seniors because it cannot place more than that in PPEs.

Glondys says she has heard of coordinators stretching to get all PPE students placed. CAHIIM best practices state that schools should only place students in acute care hospitals for their technical PPE. But at some colleges, clinics and doctor offices have been substituted as technical PPE sites if not enough acute care facilities volunteer to take on students, Glondys says. Those environments do not offer the same educational experience as an acute care hospital, according to Glondys. While it may be a quick fix to the shortage, the student suffers in the end.

Time Investment Minimal

Educators can sympathize with HIM directors leery about hosting a PPE student. “They are just so swamped as it is, and now you are expected to spend time with students? It is just one more thing to do,” Patena says.

However, Patricia Cunningham, MS, RHIA, finds there is always time to host a PPE student. In fact, this spring the 23-year HIM veteran hosted two, one of which was Jefferson. The students work on different days.

Cunningham, the senior director of revenue cycle operations at Rush-Copley Medical Center, has volunteered to host PPE students every year since 1991, when she first became an HIM director. Everyone was once a student, doing their own PPE, she says. HIM professionals took the time for her PPE, she says, and now it is time to return the favor.

All HIM professionals need to be taught their work, and exposure to the nuts and bolts of HIM is invaluable to students, she notes. “It is not an issue of why do it, the question would be why not. We all learned,” Cunningham says. “I just believe that the students have a better understanding of what they are doing when they can see it and are around it.”

During a student’s PPE, Cunningham reminds them to be a “sponge, absorb everything and pay attention to everything.” That is because students will use everything they learn in their HIM program, especially during their PPE. Cunningham still remembers her PPEs, and how they, over any other part of her HIM education, made her “100 percent sure that this would be a lifelong career.”

“The PPE is when you feel it,” she says.

Jefferson agrees. The PPE has a different feel than the classroom, she says. In the PPE, a student is immersed in the actual work, surrounded by HIM professionals putting education into practice. “It is not like, ‘Hey, this is just you learning your math in class that you know you will never use again,’” Jefferson says. “It is like, ‘These are things that you are going to have to know.’”

“One of the best ways to learn something is to see it,” Cunningham says. “You can have someone tell you what a chart pull is, but you really understand it when you do it.

When she graduates, Jefferson feels she’ll have a head start. The PPE is just the beginning in her work experience, but a good beginning. “[A PPE] just keeps you grounded,” she says. “You know exactly what you are going to be doing. When you graduate, you are going to be ready.” The hands-on experiences she does now will get her a job after graduation, she feels.

HIM directors should not expect that PPE students will be a staff member’s full-time job. Since juniors typically shadow different staff members each week, the task of hosting a student is spread across the staff, Glondys says. Over the course of the PPE, one employee hosts the student at a time.

The program is manageable, and PPE students are not a huge drain on an HIM director’s time, Cunningham says. PPEs do sometimes slow down HIM department staff productivity once a week, Cunningham admits. But as long as staffers are prepared for the student’s shadowing, the impact is minimal.

HIM professionals who agree to host a PPE student are expected to provide an adequate learning experience for the student, Patena says. UIC provides specific parameters for host sites to follow, such as how many and what types of records the student needs to code. This not only ensures the student has an educational experience, but it helps PPE mentors know how to organize the PPE over 14 weeks.

Even if the department is in flux because a new EHR system is being implemented in the facility, Patena says it would be a great time to host a student. They would see what it takes to implement a system and could even assist with the process. HIM work is naturally challenging—new systems, Joint Commission visits, and work shortages are common experiences. A student benefits by getting the true experience of the profession upfront, warts and all, she says.

Facilities Benefit, Too

HIM students are not the only ones who benefit from a PPE. Facilities reap their share of perks as well.

Students offer an objective eye on HIM operations. Since their education rests on the cutting edge of HIM, students can offer unique solutions to issues and help update HIM departments. When a student offers a suggestion on how to update her department’s older paper processes, Cunningham listens closely.

The HIM mentor gets something out of the PPE, too. First is a sense of satisfaction for helping one’s profession, Cunningham says. Student energy helps at times, too. Cunningham has had PPE students so energetic and vibrant that they perked up her own work.

There are more tangible benefits as well. PPE mentors earn CE credits for hosting students, issued by both AHIMA and sometimes the student’s school.

For strapped departments, students can be free, hard-working labor. Although juniors are green, they have the basic HIM background and education and can be put to work, Glondys says.

PPEs can be a great way to find new employees. A PPE can be like an in-depth job interview, Cunningham says. A well-performing student can be brought on immediately following the program. If a potential PPE site is strapped for personnel and is having a hard time agreeing to accept a student, PPE site coordinator Linda Galocy, RHIA, will offer the site a student with experience who can lend a hand.

Galocy, who coordinates PPE sites for Indiana University Northwest, based in Gary, tells students to put forward their best effort—it might end in a job. HIM directors around the country routinely hire students who conduct their PPEs at their facilities. According to a recent AHIMA survey, 45 percent of HIM and health IT students obtain job offers directly from their PPE experiences.

Hosting PPE students benefits all HIM professionals, Glondys says, since doing so grows the profession as a whole. “The more that sites can excite students into the work that HIM professionals do, I think we will result in a stronger, more dynamic field,” she says.

Offering a hand to the next generation helps the profession thrive. “This is my future, these students coming in here—these are the people that I’m going to be working with,” Cunningham says.

“Invest in the youth, who can pick up where you left off and take care of the profession,” Jefferson says.

PPEs Spark Excitement

After pulling charts, Jefferson spent time at the HIM help desk receiving pointers from HIM department business associate Mary Meyer on how to field drop-in HIM requests and call up records from Rush-Copley’s EHR system. A lesson on patient privacy arose when police requested information about a stab victim they thought was treated at the hospital. The request was a real-world privacy lesson, one Jefferson doubts would have come up in class.

After earning her associate’s degree, Jefferson worked for three years bouncing between “empty jobs” before she decided she wanted “something more.” After a short search, Jefferson decided to get her bachelor’s degree in HIM from UIC. She is happy with her decision, a feeling only enforced during her PPE at Rush-Copley.

The experience helped solidify Jefferson’s excitement for the profession. “This is definitely a change, but I am hoping it will pay off,” she says. “I think it will, because it just feels right.”

Chris Dimick (chris.dimick@ahima.org) is staff writer at the Journal of AHIMA.